MEDICARE: KIM HERRING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	28RI02265100	NJ

General Provider Information

NPI Number	:	1457633273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM HERRING

Provider Business Mailing Address
First Line	:	2395 JOHN F KENNEDY BLVD
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07304-1909
Country	:	US
Telephone Number	:	201-333-4092
Fax Number	:

Provider Business Practice Location Address
First Line	:	2395 JOHN F KENNEDY BLVD
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07304-1909
Country	:	US
Telephone Number	:	201-333-4092
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2011
Last Update Date	:	12/19/2022

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